Contact
Massachusetts Department of Public Health
Radiation Control Program
Attention: RT Licensing
Schrafft Center, Suite 1M2A
529 Main St.
Charlestown, MA 02129
Phone: (617) 242-3035
Fax: (617) 242-3457
- This page, Radiation Control Program application forms, is offered by
- Radiation Control Program
- Bureau of Climate and Environmental Health
- Department of Public Health
Radiation Control Program application forms
Table of Contents
Radiologic Technologist licensing
Open PDF file, 36.51 KB,
Radiologic Technologist Licensing Application Form
(English, PDF 36.51 KB)
Open DOCX file, 43.71 KB,
Radiologic Technologist Licensing Application Form
(English, DOCX 43.71 KB)
Open PDF file, 79.6 KB,
Temporary Radiologic Technologist License Application Form
(English, PDF 79.6 KB)
Open DOCX file, 41.97 KB,
Temporary Radiologic Technologist License Application Form
(English, DOCX 41.97 KB)
Open PDF file, 78.02 KB,
Radiologic Technologist License Renewal Form
(English, PDF 78.02 KB)
Open DOCX file, 32.61 KB,
Radiologic Technologist License Renewal Form
(English, DOCX 32.61 KB)
Diagnostic X-ray facility registration, including mammography
Open PDF file, 112.88 KB,
Mammography Facility License Application
(English, PDF 112.88 KB)
Open DOC file, 67.5 KB,
Mammography Facility License Application
(English, DOC 67.5 KB)
Open PDF file, 96.8 KB,
Medical X-Ray Unit(s) Registration Termination
(English, PDF 96.8 KB)
Open DOCX file, 46.16 KB,
Medical X-Ray Unit(s) Registration Termination
(English, DOCX 46.16 KB)
Open PDF file, 180.46 KB,
Shielding and Registration Requirements for New Facilities
(English, PDF 180.46 KB)
Open DOCX file, 95.35 KB,
Shielding and Registration Requirements for New Facilities
(English, DOCX 95.35 KB)
Industrial X-ray facility registration
Radioactive materials licensing
Open PDF file, 60.2 KB,
Application for Use of Depleted Uranium Under a General License
(English, PDF 60.2 KB)
Open DOCX file, 98.71 KB,
Application for Use of Depleted Uranium Under a General License
(English, DOCX 98.71 KB)
Open PDF file, 65.5 KB,
Application for In-Vitro Testing Under a General License
(English, PDF 65.5 KB)
Open DOCX file, 99.19 KB,
Application for In-Vitro Testing Under a General License
(English, DOCX 99.19 KB)
Open PDF file, 52.31 KB,
Certificate of Termination Disposition of Radioactive Material
(English, PDF 52.31 KB)
Open DOCX file, 90.14 KB,
Certificate of Termination Disposition of Radioactive Material
(English, DOCX 90.14 KB)
Open PDF file, 84.52 KB,
Application for Use of Radioactive Material
(English, PDF 84.52 KB)
Open DOCX file, 90.65 KB,
Application for Use of Radioactive Material
(English, DOCX 90.65 KB)
Open PDF file, 225.97 KB,
Application for Reciprocity for a Radioactive Materials License
(English, PDF 225.97 KB)
Open DOCX file, 634.72 KB,
Application for Reciprocity for a Radioactive Materials License
(English, DOCX 634.72 KB)
Generally licensed devices
Open PDF file, 86.71 KB,
Application for Registration of Generally Licensed Devices
(English, PDF 86.71 KB)
Open RTF file, 112.76 KB,
Application for Registration of Generally Licensed Devices
(English, RTF 112.76 KB)
Linear Accelerator registration
Laser registration
Open PDF file, 301.15 KB,
Laser Registration Form
(English, PDF 301.15 KB)
Open DOC file, 137 KB,
Laser Registration Form
(English, DOC 137 KB)
Open PDF file, 176.23 KB,
Laser Device Disposal or Transfer
(English, PDF 176.23 KB)
Open DOC file, 86 KB,
Laser Device Disposal or Transfer
(English, DOC 86 KB)
Low level radioactive waste
Open PDF file, 129.66 KB,
Calendar Year 2023 Radioactive Waste Survey
(English, PDF 129.66 KB)
Open DOCX file, 41.46 KB,
Calendar Year 2023 Radioactive Waste Survey
(English, DOCX 41.46 KB)
Occupational exposure
Open PDF file, 16.56 KB,
Cumulative Occupational Exposure History
(English, PDF 16.56 KB)
Open RTF file, 138.09 KB,
Cumulative Occupational Exposure History
(English, RTF 138.09 KB)
Open PDF file, 19.19 KB,
Occupational Exposure for a Monitoring Period
(English, PDF 19.19 KB)
Open RTF file, 45.66 KB,
Occupational Exposure for a Monitoring Period
(English, RTF 45.66 KB)
Registration of services (consultants)
Open PDF file, 54.6 KB,
Application for Registration of Services
(English, PDF 54.6 KB)
Open DOCX file, 48.41 KB,
Application for Registration of Services
(English, DOCX 48.41 KB)
Physician Assistant fluoroscopy
Open PDF file, 182.32 KB,
Request To Take the ARRT Fluoroscopy Exam
(English, PDF 182.32 KB)
Open DOC file, 52 KB,
Request To Take the ARRT Fluoroscopy Exam
(English, DOC 52 KB)
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